tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 2)

In many transplantation centers, transmission of infections that may be latent or clinically inapparent in the donor organ has resulted in the development of specific donor-screening protocols. In addition to ordering serologic studies focused on viruses such as herpes-group viruses [herpes simplex virus types 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), human herpesvirus (HHV) type 6, Epstein-Barr virus (EBV), and Kaposi's sarcoma– associated herpesvirus (KSHV)] as well as hepatitis B and C viruses, human immunodeficiency virus (HIV), human T cell lymphotropic virus type I, and West Nile virus, donors should be screened for parasites such as. | Chapter 126. Infections in Transplant Recipients Part 2 In many transplantation centers transmission of infections that may be latent or clinically inapparent in the donor organ has resulted in the development of specific donor-screening protocols. In addition to ordering serologic studies focused on viruses such as herpes-group viruses herpes simplex virus types 1 and 2 HSV-1 HSV-2 varicella-zoster virus VZV cytomegalovirus CMV human herpesvirus HHV type 6 Epstein-Barr virus EBV and Kaposi s sarcoma-associated herpesvirus KSHV as well as hepatitis B and C viruses human immunodeficiency virus HIV human T cell lymphotropic virus type I and West Nile virus donors should be screened for parasites such as Toxoplasma gondii and Trypanosoma cruzi the latter particularly in Latin America . Clinicians caring for prospective organ donors should also consider assessing stool for parasites should examine chest radiographs for evidence of granulomatous disease and should perform purified protein derivative PPD skin testing or obtain blood for immune cell-based assays that detect active or latent Mycobacterium tuberculosis infection. An investigation of the donor s dietary habits . consumption of raw meat or fish or of unpasteurized dairy products occupations or avocations . gardening or spelunking and travel history . travel to areas with endemic fungi is also mandatory. It is expected that the recipient will have been likewise assessed. Because of immune dysfunction resulting from chemotherapy or underlying chronic disease however direct testing of the recipient may prove less reliable. This chapter considers aspects of infection unique to various transplantation settings. Infections in Hematopoietic Stem Cell Transplant HSCT Recipients Transplantation of hematopoietic stem cells from bone marrow or from peripheral or cord blood for cancer immunodeficiency or autoimmune disease results in a transient state of complete immunologic incompetence. Immediately after .